Advances in Interventional Cardiology
eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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2/2025
vol. 21
 
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abstract:
Original paper

Role of age in prognostication of hospital mortality in postcardiotomy patients supported with extracorporeal membrane oxygenation

Nadežda Ščupakova
1
,
Tadas Žvirblis
2
,
Aleksejus Zorinas
3
,
Povilas Andrijauskas
4
,
Vaidas Vicka
5
,
Lina Puodžiukaitė
5
,
Pranas Šerpytis
1
,
Robertas Stasys Samalavičius
4

  1. Clinic of Emergency Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
  2. Institute of Data Science and Digital Technologies, Faculty of Mathematics and Informatics, Vilnius University, Vilnius, Lithuania
  3. Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
  4. II Department of Anaesthesiology and Intensive Care, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
  5. Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Adv Interv Cardiol 2025; 21, 2 (80): 221–228
DOI: https://doi.org/10.5114/aic.2025.151722
Online publish date: 2025/05/29
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Introduction:
Despite the growing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO), there are still no clearly defined criteria for VA-ECMO initiation in postcardiotomy (PC) patients.

Aim:
To identify the pre-ECMO risk factors associated with increased hospital mortality, paying special attention to the patients’ age.

Material and methods:
Retrospective review of consecutive adult patients supported with PC ECMO for a 16-year period in a tertiary care center. The primary outcome was all-cause mortality. Logistic regression was performed to identify mortality predictors. To determine the optimal age cut-off that most accurately distinguishes between higher and lower probabilities of mortality, the Youden index was used.

Results:
A total of 214 patients were enrolled in the final analysis and 55 (25.7%) survived until hospital discharge. Age was a significant mortality predictor with ROC-AUC of 0.596 (0.508–0.685), p = 0.033. Multivariable logistic regression showed that age over 60 years (OR = 2.119 (95% CI: 1.055, 4.255), p = 0.035), male gender (OR of 0.415, indicating a protective effect) (95% CI: 0.198, 0.869), p = 0.020), pre-ECMO vasoactive inotropic score (VIS) (OR = 1.015 (95% CI: 1.002, 1.027), p = 0.019), and mechanical ventilation duration before ECMO (OR = 1.053 (95% CI: 1.014, 1.092), p = 0.007) remained as independent prognostic factors.

Conclusions:
Our study confirms that advanced age is a prognostic marker of mortality in PC ECMO patients and doubles the mortality risk above 60 years. However, age must be considered alongside other mortality predictors. These findings can significantly contribute to the decision-making process.

keywords:

risk factors, elderly, postcardiotomy, venoarterial extracorporeal membrane oxygenation
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